Dr. Joseph Webb

Author: Dr. Joseph Webb

November is Diabetes Awareness Month, unfortunately the national data on this topic is distressing.

In 2018, more than 34 million Americans (about one in ten Americans of all ages, including one in seven adults[1]) had diabetes, and 88 million American adults (approximately one in three) had prediabetes, a state of increased risk for type 2 diabetes and cardiovascular disease.[2] More significant, many teenagers are developing what was once considered a disease of older people; 40% of young adults will be diagnosed with it at some point in their lives. If current trends continue, one in three Americans will develop diabetes in their lifetime.[3]

Closer to home, approximately 730,416 people in Tennessee (13.6% of the adult population) have been diagnosed with diabetes. Furthermore, 1,792,000 people in Tennessee, (34.3% of the adult population) have prediabetes, and an additional 158,000 people in Tennessee have diabetes but don’t know it, significantly increasing their health risk.[4]

In the U.S., diabetes is a leading cause of blindness in adults, kidney failure and lower-limb amputations and is a significant contributor to death, including death from COVID-19. Individuals with poorly controlled diabetes have at least a two-fold greater risk of death from COVID-19. 

The Financial Cost 

Caring for diabetes is a significant financial burden. Nationally, the total cost of diabetes was $327 billion in 2017, including $237 billion in direct medical costs and $90 billion in reduced productivity.5 Medicare and Medicaid paid about 67% of diabetes costs.[5] Caring for people diagnosed with diabetes accounts for one of every four healthcare dollars, making diabetes the costliest chronic condition in the U.S.[6]

In Tennessee, the total direct medical expenses for diagnosed diabetes were estimated at $5.2 billion in 2017. And another $2.1 billion was spent on indirect costs from lost productivity due to diabetes. 

Food as Medicine

When we think of medicine to treat diabetes, we typically think of pills and insulin injections to improve glycemic control. However, science points to a new treatment for diabetes and other chronic conditions: food. 

Paying attention to calories, fat, and carbohydrates is vital to a person with diabetes, but food as medicine goes further. Affordable, nutritious food that is anti-inflammatory complements diabetes medication regimes. But it’s difficult to leverage food as medicine when barriers exist to acquiring and cooking healthy food. 

A Societal Issue

Forty-nine million people in the United States experience food insecurity; a lack of access to affordable, nutritious food. This is a major cause for concern, given the impact of nutrition on the prevention and management of diabetes.[7] Locally, in Davidson County alone, one in six households are experiencing food insecurity.  

Food insecurity can be due to various factors, including reliable and affordable transportation, mobility issues, inconvenient access to healthy foods, financial struggles, lack of time, and inadequate cooking expertise. Therefore, food-insecure people with type 2 diabetes may find themselves limited to purchasing inexpensive, high-calorie, nutritionally poor foods including foods high in refined carbohydrates instead of more healthful items such as vegetables, lean proteins, and whole grains.

The Food Pharmacy at Nashville General Hospital

As mentioned earlier, healthy foods low in sugar, carbohydrates, and fats go a long way in helping patients manage their diabetes. And in keeping with this “food as medicine” approach to managing diabetes, Nashville General Hospital (NGH) established Tennessee’s first Food Pharmacy.

The Food Pharmacy at NGH addresses food insecurity of patients by providing nutritional tote bags of fresh produce and shelf-stable foods—at no cost.

NGH’s Food Pharmacy should not be confused with a food pantry. The Food Pharmacy provides nutritional food totes to patients enrolled in NGH’s care management program.  Patients in care management receive a prescription to the Food Pharmacy for foods specific to their disease state. A registered dietician works directly in the Food Pharmacy to educate patients about which foods best fit within their care plan based on their chronic conditions. Someone with diabetes receives education regarding which foods increase or lower their glucose levels. And often, inexperience in preparing healthy meals is a barrier, so patients receive instructions on how to prepare these foods healthily with the tools they have in their household.

Is the NGH Food Pharmacy really a viable component in treating diabetes? NGH has seen a 20% increase in the number of patients in control of their diabetes compared to 2019. By addressing societal issues such as food insecurity, Nashville has a healthier population.  

What Can You Do?

To learn more about Nashville General Hospital’s Food Pharmacy visit: Food Pharmacy. To learn more about diabetes go here. To support this work, click here.

To identify a household struggling with food insecurity – please email to food@nashvilleha.org: name of head of household, delivery address with zip, working phone number and # of individuals in the home. 


[1] Wang L, Li X, Wang Z, et al. Trends in Prevalence of Diabetes and Control of Risk Factors in Diabetes Among US Adults, 1999-2018. JAMA. Jun 25 2021;doi:10.1001/ jama.2021.9883 

[2] Centers for Disease Control and Prevention. National Diabetes Statistics Report, 2020: Estimates of Diabetes and Its Burden in the United States. U.S. Department of Health and Human Services. 2020. https://www.cdc.gov/diabetes/pdfs/data/statistics/ national-diabetes-statistics-report.pdf 

[3] Boyle JP, Thompson TJ, Gregg EW, Barker LE, Williamson DF. Projection of the year 2050 burden of diabetes in the US adult population: dynamic modeling of incidence, mortality, and prediabetes prevalence. Popul Health Metr. Oct 22 2010;8:29. doi:10.1186/1478-7954-8-29 

[4] https://diabetes.org/sites/default/files/2022-04/ADV_2022_State_Fact_sheets_all_rev_TN-4-4-22.pdf

[5] American Diabetes Association. Economic costs of diabetes in the U.S. in 2017. Diabetes Care. May 2018;41(5):917-928. doi:10.2337/dci18-0007 

[6] Dieleman JL, Baral R, Birger M, et al. US spending on personal health care and public health, 1996-2013. JAMA. Dec 27 2016;316(24):2627-2646. doi:10.1001/ jama.2016.16885 

[7]  Coleman-Jensen A, Rabbitt MP, Gregory CA, Singh A. Household food security in the United States in 2018. US Department of Agriculture Economic Research Service. September 27, 2019. Accessed June 1, 2020. https://www.ers.usda.gov/publications/pub-details/?pubid=94848

[1] Wang L, Li X, Wang Z, et al. Trends in Prevalence of Diabetes and Control of Risk Factors in Diabetes Among US Adults, 1999-2018. JAMA. Jun 25 2021;doi:10.1001/ jama.2021.9883 

[1] Centers for Disease Control and Prevention. National Diabetes Statistics Report, 2020: Estimates of Diabetes and Its Burden in the United States. U.S. Department of Health and Human Services. 2020. https://www.cdc.gov/diabetes/pdfs/data/statistics/ national-diabetes-statistics-report.pdf